Comparing two approaches to remote biochemical verification of self-reported cessation in very low-income smokers

Abstract

Highlights Low-income smokers preferred urine tests over breath tests to confirm cessation. Rates of completing in-home urine tests were comparable to rates in prior studies. Many digital photos of urine test results were inconclusive, limiting their value. Urine tests are acceptable to low-income smokers, but need to yield clearer results.

Review of strategies to investigate low sample return rates in remote tobacco trials: A call to action for more user-centered design research

“…However, no study systematically evaluated participants’ technology literacy, a topic that has recently been discussed in the smoking cessation literature [ 22 ]. Finally, some studies explicitly identified psychosocial factors such as transportation barriers and socioeconomic status as barriers to specific sample collection procedures [ 23 ]. However, these factors, which are directly tied to the health equity of the sample collection procedure, were barely discussed in the studies we reviewed.…”

“…Among them we would like to highlight two studies that utilized useful or creative designs to evaluate sample collection procedures. Garg et al [ 23 ]. conducted a feasibility study that offered participants to choose among different biochemical verification methods among low-income smokers.…”

“…Health equity considerations in the remote collection of biomarkers have been pointed out by several researchers in recent years. For example, one of the articles that we reviewed indicated that 70% of African American participants in this study were more likely to take a remote urine test versus an office-based carbon monoxide (CO) test [ 23 ], and the study identified digital divide and transportation barriers as possible causes for this result. This could negatively affect the collection of samples from African American smokers in current research protocols relying on CO devices.…”

Stress, depression, sleep problems and unmet social needs: Baseline characteristics of low-income smokers in a randomized cessation trial

“…The primary study outcome for the RCT is 7-day point prevalence abstinence measured at 6-month follow-up. Some participants participated in a biochemical validation sub-study by completing either a breath test that measured CO or a urine test that measured cotinine to confirm self-reported abstinence [ 38 ]. Study outcomes will be reported in a future paper when participants have completed follow-up.…”

Commentary on Graham et al.: Biochemical verification of abstinence in remotely conducted smoking cessation trials should not be a universal design requirement for rigor

“…The latter issues are increasingly being acknowledged among researchers on professional listservs and in other professional discussion forums. The extent of problems with remote testing may well be under‐reported in the literature, although some published studies have reported substantial rates of unusable samples [5] or inconclusive results [6] as well as systematically different readings from a smartphone‐connected remote CO monitor relative to other models made by the same company [7].…”